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  • Reach-B Form
  • Further information on REACH-B

This form is designed for current community hepatitis B s100 prescribing clinicians. It is not for community members or general clinicians. If you are not a prescriber but have a question for ASHM please contact [email protected]

REACH-B

  • REACH-B: Advice – Online Form

    Please provide patient case information using the form below and a specialist will be in touch to provide support within 48 hours. You are welcome to use the form multiple times for different cases or questions. You will receive a PDF of the completed form to your email upon submission. Patient data is de-identified and collected for the REACH-B Study.

    * Indicates required field


    Please ensure that no identifying patient information is included in your submission and that patient confidentiality is maintained.

  • DD slash MM slash YYYY
  • HBV s100 Prescriber information

  • Please use a personal email address NOT a general clinic email
    Please note: if we are unable to contact you by phone we will send an email response
  • Patient/case details

  • DD slash MM slash YYYY
    Interpretation of blood results and normal ranges can change depending on a person’s gender/sex.
  • Serology and clinical information

    Please advise on results of most recent tests
  • Please enter a number
  • Please enter a number less than or equal to 99.
  • i.e., Fibroscan or similar
    If not, please consider ordering updated serology or imaging
  • If available, please consider including information on/results: Co-infection (Hepatitis C, HIV, Hepatitis D) and current management of this; Any assessment of liver disease: APRI if available, Fibroscan and/or Liver ultrasound; If relevant: anti-HBc IgM = positive/negative; All other relevant context and information.
  • Please consider including information on: Other relevant blood test results including FBE, LFT & INR; Patients’ BMI; Any other comorbidities Any relevant family history (especially HCC); List of current medications
    Multiple options available
  • Additional files

    Please attach any supporting information that might be useful such as pathology results, imaging, case notes etc. Please note: these must be de-identified and not contain any identifiable patient information.
  • Accepted file types: jpg, png, pdf, Max. file size: 5 MB.
  • This field is for validation purposes and should be left unchanged.
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